Abstract: SA-PO0460
Barriers to Use of Evidence-Based Medication Therapy in Cardiovascular-Kidney-Metabolic Syndrome: A Qualitative Study
Session Information
- CKM: Clinical - Screening, Population Management, Care Disparities, and Patient-Centered Outcomes
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Cardiovascular-Kidney-Metabolic Health
- 602 Cardiovascular-Kidney-Metabolic Health: Clinical
Authors
- Weltman, Melanie R., University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania, United States
- Lavenburg, Linda-Marie Ustaris, University of Pittsburgh Division of Renal-Electrolyte, Pittsburgh, Pennsylvania, United States
- Jhamb, Manisha, University of Pittsburgh Division of Renal-Electrolyte, Pittsburgh, Pennsylvania, United States
Background
New evidence-based medication therapy (EBMT), including SGLT2 inhibitors (SGLT2i), GLP1 receptor agonists (GLP1RA), and a nonsteroidal mineralocorticoid receptor antagonist (nsMRA), have shown benefits across the spectrum of cardio-kidney-metabolic syndrome (CKM) but remain widely underutilized. Limited prior studies have taken a comprehensive approach to elicit barriers to use of CKM EBMT from specialists and primary care. Our objective is to identify barriers and facilitators to use of CKM EBMT through qualitative interviews with diverse stakeholders.
Methods
We developed an interview guide based on the capability, opportunity, and motivation-behavior (COM-B) model to deduce how these factors interact to influence the behavior of EBMT prescription. Study participants are physicians and advanced practice professionals from cardiology, endocrinology, nephrology, and primary care. Recruitment began in April 2026 and is ongoing, targeting 16-20 participants. Interviews are being audio recorded and transcribed verbatim. The primary coder (MW) developed a preliminary codebook inductively from completed interviews and deductively using COM-B. Analysis will incorporate conventional content and thematic analysis.
Results
To date, 3 interviews have been completed with 1 endocrinologist, 1 nephrology nurse practitioner, and 1 primary care physician. In preliminary content analysis based on deductive coding, EBMT prescribing was influenced by 1) Capability: participants understood the risks/benefits of EBMT and were confident in their ability to risk-stratify; 2) Opportunity: reported barriers to EBMT included managing a complex patient population with limited visit time, medication cost, drug shortages, need for dose titration, burdensome prior authorizations, and formulary restrictions. Participants described more barriers to prescribing GLP1RA and nsMRA compared to SGLT2i; 3) Motivation: cardio-kidney protective benefits motivated clinicians to prescribe EBMT. Participants felt that increased interspecialty collaboration would help with management of patients with CKM, describing EBMT prescribing as a "shared responsibility."
Conclusion
Preliminary findings indicate that clinicians face multilevel barriers to use of CKM EBMT and desire increased collaboration in patient care. Completion of this research will inform future opportunities to optimize the care of individuals with CKM.
Acknowledgment
This research was supported with grant funding from Dialysis Clinic, Inc.
Funding
- Private Foundation Support